There is pressing need to improve access to specialized care for rural veterans. This CDA-2 will provide the nominee with the skills necessary to design, evaluate, and implement strategies to deliver accessible and high-quality specialty care in rural areas. Proposed research focuses on human immunodeficiency virus (HIV) infection as a model for conditions requiring specialized care from experienced providers. Prior work has described gaps in care for rural persons with HIV, both outside of and within VA. Three projects will leverage existing VA resources to develop an innovative delivery model to improve the accessibility, quality, and outcomes of care for rural veterans with HIV. The first project applies secondary analysis of existing VA HIV Clinical Case Registry (CCR) data to provide a detailed description of gaps in care for rural veterans with HIV. Dependent variables will include a series of process and outcome measures of HIV care tracked in VA. Project #2 employs qualitative methods and semi-structured interviews with veterans, VA providers, and administrators to identify opportunities to improve care for rural veterans with HIV. Interviews will focus on perceived needs for care among rural veterans with HIV, enabling resources that influence care access, needs for additional resources in low HIV-volume sites serving rural areas, and specific opportunities to improve care. The third project will apply these findings to develop and evaluate an innovative, telehealth-based delivery model to close gaps in care for rural veterans with HIV. During this work the nominee will 1) acquire skills for assessing health care quality for rural populations; 2) develop expertise applying qualitative and mixed research methods to the design and evaluation of healthcare interventions; 3) develop expertise in telehealth interventions for rural persons with chronic conditions; 4) develop expertise in quasi-experimental and randomized trials to determine the impact of healthcare interventions on outcomes and costs; and 5) acquire fluency in implementation science. Three accomplished VA investigators will provide mentorship. Dr. Eli Perencevich is an infectious disease specialist and HSR&D funded health services researcher. Dr. Bonnie Wakefield is a nationally recognized authority in the design and evaluation of telehealth interventions. Dr. Amy Justice will provide mentorship in the area of HIV outcomes research. Over the course of his research career in VA, the nominee will apply the skills gained during this CDA to improve the accessibility and quality of care for rural veterans with infectious diseases requiring specialized care. Thus, the research and career development goals in this application directly address the VA operational mandate and HSR&D priority to improve access for rural veterans. PUBLIC HEALTH RELEVANCE: There is pressing need to develop innovative strategies to improve access to specialized healthcare for veterans living in rural areas. The work proposed in this CDA-2 application will develop and evaluate an innovative delivery model to improve the accessibility and quality of care for rural veterans with human immunodeficiency virus (HIV) infection, a chronic condition that requires specialized care from experienced providers. During this work the nominee will acquire skills necessary to develop, evaluate, and implement strategies to improve rural healthcare delivery. Over the course of his career in VA, he will apply these skills to improve access for rural veterans with a range of infectious diseases that require specialized care. Thus, the research and career development goals in this application directly address the VA operational mandate and HSR&D priority to improve access for rural veterans.